RARE INTRAOPERATIVE FIND — ADENOCARCINOMA OF THE APPENDIX: CLINICAL CASE

Abstract

Relevance: Neoplasms of the large bowel are one of the most common diseases among all malignant neoplasms of the gastrointestinal tract. The predominant localization is the rectosigmoid junction. The rarest disease is a neoplasm of the appendix. Purpose: Diagnosis of the neoplasm of the appendix with extension into cecum cupula and into the anterior abdominal wall and description of the results on the example of a clinical case. Materials: We present a case of patient I., male, 34 years old. He is a hypersthenic overweight person, essential hypertension stage I, rate III, risk 3. Results: Patient I. was first admitted in a private clinic (Tver, Russia) in September 2020 after the 1 day of onset. A clinical presentation complies with appendicitis. He was sent to the emergency surgery department after the examination by the surgeon. There he underwent a diagnostic laparoscopy, conversion, laparotomy with preservation of the appendix, and draining of the abdominal cavity. The second visit to a private clinic was in May 2021. The CT scan of the abdominal organs was performed and an infiltrate was detected in the cecum cupula with a small area of suppurative complication. Then the patient was hospitalized in the surgery department, where he was prescribed antibiotic therapy for periappendiceal mass and recommended a planned appendectomy. In September 2021, the patient turned to the surgery department at the place of residence due to the deterioration. He underwent a laparotomy in the right iliac region, viscerolysis, median laparotomy, rightsided hemicolectomy for adenocarcinoma of the appendix, ileotransverse anastomosis by the side-to-side method, drainage of the abdominal cavity. Conclusion: Acute appendicitis remains a challenge for practicing surgeons despite being common and well-studied. Acute appendicitis is characterized by pronounced clinical symptoms. But it also has many hidden forms that mimicked other diseases. That’s why the establishment of this diagnosis is difficult even for experienced clinicians. This clinical case demonstrates certain difficulties in the timely diagnosis of the appendix neoplasm. This is because the development of most appendix tumors is asymptomatic or resembles the clinic of acute appendicitis. The tumors are detected by chance, or during visualization, or during appendectomy. Only early diagnosis of the disease, knowledge of the treatment strategy and timely initiation of appropriate therapy can improve the prognosis of patients, reduce the risk of disability and death. It is undoubtedly important in clinical practice.